PEPFAR has saved lives – and not just from HIV/AIDS, Stanford study finds

PEPFAR, the largest U.S. initiative ever devoted to a single disease, has helped save lives from all causes, not just HIV/AIDS, a new Stanford study has found. The program, officially known as the President’s Emergency Fund for AIDS Relief, was begun in 2003 under President George W. Bush and is considered one of his greatest achievements. Though its goal was primarily to fight HIV/AIDS, the new study suggests it has had a spillover effect, benefiting individuals with other health problems as well.

The researchers examined the benefits of the program in nine of the countries targeted and found that it saved 740,000 lives there between 2004 and 2008. Of these, some 630,000 were associated with HIV/AIDS. Eran Bendavid, MD, the study’s first author, told me:

We were surprised and impressed to find these mortality reductions. While many assume that foreign aid works, most evaluations of aid suggest it does not work or even causes harm. Despite all the challenges to making aid work and to implementing HIV treatment in Africa, the benefits of PEPFAR were large and measurable across many African countries.

The study appears today in the Journal of the American Medical Association, which published an accompanying editorial by Ezekiel Emanuel, MD, PhD, a distinguished physician/ethicist at the University of Pennsylvania. He wrote:

The article by Bendavid et al. is welcome news in helping to document the even greater benefits of PEPFAR not only on HIV/AIDS but on overall mortality in countries.

Emanuel said the study should help counter arguments that PEPFAR has been “crowding out” funding for other health priorities and thus having an adverse effect on overall health. The study suggests just the opposite. Still, he notes that there are other highly prevalent conditions in Africa, such as pneumonia, diarrhea and malaria, that can prevented or treated at relatively low cost. He concludes:

The fundamental ethical, economic and policy question is not whether PEPFAR is doing good, but rather whether other programs would do even more good in terms of saving life and improving health. Clearly, besides treatment for HIV/AIDS, there are other highly effective and lower-cost interventions for the world’s poor.